Incidence and predictors of obstetric and fetal complications in women with structural heart disease.

Détails

ID Serval
serval:BIB_3DAEF5413E49
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Incidence and predictors of obstetric and fetal complications in women with structural heart disease.
Périodique
Heart
Auteur⸱e⸱s
van Hagen I.M., Roos-Hesselink J.W., Donvito V., Liptai C., Morissens M., Murphy D.J., Galian L., Bazargani N.M., Cornette J., Hall R., Johnson M.R.
Contributeur⸱rice⸱s
Rutz Tobias, Bouchardy Judith
ISSN
1468-201X (Electronic)
ISSN-L
1355-6037
Statut éditorial
Publié
Date de publication
10/2017
Peer-reviewed
Oui
Volume
103
Numéro
20
Pages
1610-1618
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Women with cardiac disease becoming pregnant have an increased risk of obstetric and fetal events. The aim of this study was to study the incidence of events, to validate the modified WHO (mWHO) risk classification and to search for event-specific predictors.
The Registry Of Pregnancy And Cardiac disease is a worldwide ongoing prospective registry that has enrolled 2742 pregnancies in women with known cardiac disease (mainly congenital and valvular disease) before pregnancy, from January 2008 up to April 2014.
Mean age was 28.2±5.5 years, 45% were nulliparous and 33.3% came from emerging countries. Obstetric events occurred in 231 pregnancies (8.4%). Fetal events occurred in 651 pregnancies (23.7%). The mWHO classification performed poorly in predicting obstetric (c-statistic=0.601) and fetal events (c-statistic=0.561). In multivariable analysis, aortic valve disease was associated with pre-eclampsia (OR=2.6, 95%CI=1.3 to 5.5). Congenital heart disease (CHD) was associated with spontaneous preterm birth (OR=1.8, 95%CI=1.2 to 2.7). Complex CHD was associated with small-for-gestational-age neonates (OR=2.3, 95%CI=1.5 to 3.5). Multiple gestation was the strongest predictor of fetal events: fetal/neonatal death (OR=6.4, 95%CI=2.5 to 16), spontaneous preterm birth (OR=5.3, 95%CI=2.5 to 11) and small-for-gestational age (OR=5.0, 95%CI=2.5 to 9.8).
The mWHO classification is not suitable for prediction of obstetric and fetal events in women with cardiac disease. Maternal complex CHD was independently associated with fetal growth restriction and aortic valve disease with pre-eclampsia, potentially offering an insight into the pathophysiology of these pregnancy complications. The increased rates of adverse obstetric and fetal outcomes in women with pre-existing heart disease should be highlighted during counselling.
Mots-clé
Adult, Cohort Studies, Female, Fetal Death, Heart Diseases/epidemiology, Humans, Incidence, Infant, Newborn, Infant, Newborn, Diseases/epidemiology, Pregnancy, Pregnancy Complications, Cardiovascular/epidemiology, Pregnancy Outcome, Registries, Risk Factors, Young Adult, Congenital heart disease, Prediction, Valvular heart disease
Pubmed
Web of science
Création de la notice
08/08/2017 18:31
Dernière modification de la notice
16/10/2019 5:13
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